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General NPI Number Information
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NPI Number | 1780813485
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Entity Type | Organization
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Legal Business Name | ALTA BATES SUMMIT MEDICAL CENTER
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Dates
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Enumeration Date | 07/02/2009
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Last Update Date | 01/20/2022
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Provider Practice Location Address
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Address Line | 3100 SUMMIT ST
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City | OAKLAND
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State | CA
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Zip | 94609-3412
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Country | US
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Telephone | 510-869-8451
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Fax | 510-869-8458
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Provider Business Mailing Address
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Address Line | PO BOX 742585
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City | LOS ANGELES
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State | CA
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Zip | 90074-2585
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Country | US
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Telephone | 510-869-8451
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Fax | 510-869-8458
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Authorized Official
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Title or Position | PHARMACIST
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Name | MICHELLE SO
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Credential | PHARM.D.
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Telephone | 510-869-8456
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY49947
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License Number State | CA
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